Interagency group taking data-driven approach to combat health care fraud
FAIRMONT, WEST VIRGINIA – State and federal law enforcement leaders joined United States Attorney William J. Ihlenfeld, II today to announce the formation of a working group that is taking a data-driven approach to the prevention of health care fraud in West Virginia.
According to Ihlenfeld, the multi-jurisdictional group is proactively evaluating the health care reimbursement data of medical providers in northern West Virginia. By using advanced statistical analysis, investigators are able to identify potentially fraudulent billing patterns and uncover waste and abuse more efficiently.
“Health care fraud continues to be a significant problem in West Virginia and throughout the country and it costs taxpayers tens of billions of dollars every year,” said Ihlenfeld. “Ultimately, health care fraud increases the cost of medical care for everyone and undermines our existing health care programs. The fraud detection tools that we’re using allow us to identify sophisticated schemes that may have escaped scrutiny in the past.”
Agencies involved in the effort include the United States Department of Health and Human Services (HHS), the Drug Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), the Internal Revenue Service Criminal Investigations (IRS-CI), the West Virginia Medicaid Fraud Control Unit, the Ohio Medicaid Fraud Control Unit, the West Virginia Office of the Insurance Commission, and the Ohio Bureau of Workers’ Compensation.
The northern West Virginia working group is led by Assistant U.S. Attorney Sarah Montoro.
On Thursday, Ihlenfeld also announced that the United States has settled allegations that a Fairmont physician fraudulently requested reimbursement for medical services that were not actually rendered. Dr. Samer Kuzbari has paid $440,232 to resolve accusations that he submitted false claims to various health care benefit programs, including Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefit Program.
The settlement addressed claims against Kuzbari and the Kuzbari Clinic arising under the False Claims Act, a law which allows the government to sue health care providers who submit false claims to federal health care benefit programs. The settlement resolves potential civil and administrative monetary claims, but does not preclude criminal charges.
“Medicare, TRICARE, and other programs depend upon doctors to honestly report the work that they do,” said Ihlenfeld. “When a doctor claims reimbursement for a treatment that he didn’t provide then it’s the taxpayers who are cheated. We will continue to work with our law enforcement partners to protect the integrity of all federal health care programs.”
Assistant U.S. Attorney Alan G. McGonigal represented the government in the Kuzbari matter. The U.S. Department of Health and Human Services Office of Inspector General, the U.S. Officer of Personnel Management Office of Inspector General, and the West Virginia Insurance Commission investigated.